| NPI | 1700278199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL BAILEY VICKERY Owner 770-378-0328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 26446) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2019-03-19 |